This week in Parkland Morning Report we discussed with Dr. Luby about liver abscess. Below are some key points and pertinent links including a review from The Surgical Clinics of North America and The Johns Hopkins Antibiotic (ABX) Guide:
- Patients who are diabetic and immunocompromised have higher risk of developing pyogenic hepatic abscesses. Other risk factors include biliary obstruction/stenting/instrumentation as well as other intra-abdominal infections and inflammatory processes (ie diverticulitis, pancreatitis, appendicitis).
- CT scan with contrast of abdomen is preferred imaging modality. Peripheral enhancement of abscess wall is virtually diagnostic.
- Common organisms include gram negative aerobes (E coli, Klebsiella, Proteus, Enterobacter cloacae), gram positive aerobes (Strep milleri, Staph aureus, Enterococcus), fungal (Candida, Aspergillus, Actinomyces) and parasites (Entameba histolytica, Fasciola Hepatica, Clonorchis Sinensis).
- Initial treatment includes drainage of abscess, broad spectrum antibiotics while cultures are pending, and treating underlying cause (diabetes, appendicitis).
- Empiric antibiotic regimens until cultures return include: ampicillin/gentamicin/metronidazole, piperacillin/tazobactam +/- metronidazole if concern for amebic abscess, carbapenem.
- Consider oral fluroquinolone for prolonged therapy after completion of IV antibiotics.
- If no improvement with above measures, may need surgical intervention such as partial liver resection.